1. Worldwide, more than half of the deaths in children under five years of age were attributed to an infectious cause, with 44% of deaths occurring in the neonatal period.
2. The top three causes of mortality in children under five were pre-term birth complications, pneumonia, and intrapartum complications.
3. If current mortality trends are projected forward, a third of the countries examined in this study would not meet under-5 mortality goals set by 2030.
Evidence Rating Level: 2 (Good)
Study Rundown: Worldwide, countries have made significant strides in reducing infant and child mortality. Between the years 2000 and 2013, mortality rates in children under five years old fell by 3.6 million, despite a rising live birth rate. The Lancet Commission on Investing in Health and the Sustainable Development Goals have set targets to reduce mortality including an under-5 mortality of 25 or fewer deaths per 1000 live births in 2030 and an under-5 mortality of 20 or fewer deaths per 1000 live births in 2035. This study’s aim was to identify the leading causes of death in neonates and children aged 1-59 months old, thereby providing a clearer picture of the areas of healthcare that require the most improvement. For most countries, the investigators used data from the WHO vital registration system, or applied either a vital registration or verbal autopsy data-based model for countries with inadequate vital registration, to estimate the causes of death in children under 5 years old from 2000-13 and cause-specific mortality scenarios in 2030 and 2035.
The results revealed that half of all deaths in children before the age of 5 were due to infectious causes and more than two-fifths of all deaths were in the neonatal period. The most common causes of death overall were from preterm birth complications, followed by pneumonia, and intrapartum-related complications. Projecting forward, they also found that more than a third of countries examined would not meet the 2030 goal, with three-quarters of those countries located in sub-Saharan Africa. The authors suggest that more evidence is still needed to further estimate child survival in the future and end preventable child deaths.
This study was funded by the Bill and Melinda Gates Foundation
In-Depth [retrospective cohort]: This study investigated worldwide mortalities trends in children under five years old in 166 countries, with 112 data points consisting of >98,000 neonatal deaths and 128 data points consisting of >320,000 deaths in children aged 1-59 months. The results showed that over a third (57 of 166) of those countries, would not meet the 2030 mortality goals. Looking more closely at the causes of mortality, out of the 6.3 million children under age 5 who died in 2013, over half (51.8%, 3.256 million) were from infectious causes. Pneumonia (0.935 million deaths, 14.9% of overall deaths), diarrhea (0.578 million 9.2%), and malaria (0.456 million, 7.3%) were the leading infectious causes of death. Importantly, 44% (2.761 million) of the under-5 deaths happened in the neonatal period, with pre-term complications as the most common cause of death (15.4%, 0.965 million), followed by intrapartum complications (0.662 million, 10.5%), such as birth asphyxia. The countries that carried the highest mortality burden in 2013 were located in sub-Saharan Africa and Southeast Asia, with the former contributing 49.6% (3.113 million) of the total under-5 deaths and the latter contributing 32.1% (2.015 million) deaths. However, between 2000 and 2013, those two regions also had the highest absolute reduction in under-5 deaths. The countries with the highest number of under-5 deaths were India, Nigeria, Pakistan, Democratic Republic of the Congo, and China.
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